On Thursday, March 21, Governor Steve Bullock came to Red Lodge to visit the Beartooth Billings Clinic (BBC) and talk to the staff. He was discussing the need for public support immediately for House Bill 590, sponsored by Rep. Chuck Hunter of Helena, to provide medical access for tens of thousands of Montanans using federal funds.
“The bill would allow Montana to accept $6.5 billion dollars of federal funding over seven years,” said Bullock. “It would expand the Medicaid program to individuals and families living below 138 percent of the federal poverty level. Through Access Health Montana, we can provide access to health care to 70,000 more Montanans, create 5000 new jobs next year and take some long-overdue steps to improve the quality of care we provide and contain costs,” he said.
He was met as he entered, by members of the BBC staff, Board and Foundation. He toured the facilities along with members of his staff. He was greatly impressed by the services offered and its cost efficiency.

Emergency care is a huge cost to health services borne by the public. Bullock believes preventative measures as offered by this bill would strive to reduce these massive costs.
BBC CEO, Kelley Evans said, “We were pretty mindful in pulling our model together not to duplicate services in acute care. In 2008, we integrated with the Red Lodge Branch Clinic of the Billings Clinic and that gave us even more efficiency.”
Bullock responded to comments that the federal government won’t keep its promises. “We have a circuit breaker in this plan. If it didn’t work out we can certainly change our program.”

He said there would be an eventual contribution by the state but that it would only go from 2 percent of the annual amount starting in 2015 to be phased in to a total of 10 percent by 2021. “With the government paying 90 percent and Montana 10 percent max.” He said it was a good deal for Montana.

If the funds are refused, he said they would not go to Montana for another purpose but to other states that want them. “We don’t want our tax dollars going to Arizona,” he added.
Bullock wanted to make clear that this issue is separate and should not be lumped with the Affordable Care Act.
Evans said there were two access points to those who could not afford insurance: Emergency Department and same day care. “You can come in without an appointment to be assessed and care triaged to the appropriate department and to the right level of care. It cuts costs in ER. We are the rural model for this procedure.”
She noted that this method has increased the local population’s use as a service to the general community while maintaining service to BBC’s traditional population.
“Phone calls matter,” said Bullock, in response to comments about eliciting support from legislators.

He said people should not be discouraged if they do not receive a personal reply. “The messages pile up and even if they don’t return the calls, they see that pile; they matter,” said Bullock.
BBC Governing Board Chair Steve Muth agreed with the expansion. “These are hard working people who have jobs but not insurance.” He said it is common sense to provide for these people and to also take this opportunity to create 12,000 jobs in Montana.

The Association of Montana Health Care Providers (MHA) is even more optimistic. It states that studies show that 12,000-14,000 Montana jobs will be created by this bill. “Many of these jobs will be high-paying jobs in health care,” according to MHA. It states that many uninsured Montanans are less healthy than those insured, avoiding routine care and health screenings. To offset these costs, premiums on insured Montanans rise. In addition to assisting in covering these costs, the bill is expected to reduce the number of high cost emergency room visits if people can obtain preventative care. Their local “ER” would no longer be a place of last resort.
Included in the expanded care would be over 9,500 Montana veterans and spouses, of which 9,000 currently have no insurance. Currently, only a family of four earning less than $13,000 would qualify for Medicaid health care. The expansion would increase that coverage to a family of four earning less than $32,000, annually.

Regardless of whether this bill is passed and federal aid accepted, MHA notes that the feds will reduce Medicare and Medicaid payments to hospitals by $400 million over the next ten years to absorb the federal costs to this national program. If Montana doesn’t take federal assistance it will still bear some of the cost.

Dr. William George, BBC Medical Director added, “If we opt out, the funds will not go to Montana. At its core, it's about that simple.”
George encouraged the public to support this new proposal. He noted that 70 percent of Montanans supported the CHIPS program, which also expanded Medicaid.
“There’s been a lot of talk but not about costs. It starts here: less costs, less advanced diseases,” he said. “Costs are going down, costs are shifting to cover those who need it. Let’s keep people healthy at the front. Let’s manage diabetes and heart disease through wellness and maintenance, not at our emergency departments. It’s a no-brainer.”
The House and Senate have started hearings on the bill this week. It is not known how quickly this bill will come to vote.